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� � � <br />H <br />�H� <br />H�H <br />K n <br />ro�ro <br />N <br />yN <br />% <br />o�° <br />��8 <br />p� f] <br />H <br />'�!. M <br />�NH <br />� <br />��+ <br />�O[�i� <br />�-. .�- <br />APPLICATIdr�l FOR CONSTRUCT�ON PERMIT <br />everett I <br />tne E�+er9reen � <br />CITY OF <br />everett <br />- BUILDING DEPARTMENT <br />259-8810 TO BE COMPLETED IN INK—PLEASE PRINT <br />DEMOUTION COMBINATION BUILDING MECHANICAL PLUMBINIG SIGN <br />OWNER MRILADORE55 CITV 2�P PHONE <br />�/i r% S�.a/ -ss. '�y/ 9 H a�,9,.._ o✓ E �...�n �.....r 7z-� ,. �^9_ U/s9 <br />TENFN7 MRILADDRE55 Cltt ZIP PHONE <br />ARCMITECTOR�ESiGNER MAILA�DRE55 C�TY ZiP PMONE <br />GENERALCONTRACTOR MAILRDDRE55 L11Y ZiP PHONE LILENSE� <br />7 �vG� 7 cT R�9v �»i.�,�s' l/- c.-s 9.99S�o G.�? �y_96 �ii»A��,v.w-i+9oo <br />MEGHANICRLCONTRRGTOR �rMdILADDRE55 � ��T�' I�P PNONE LICENSE <br />PLUMOMGCOHTRALTOR MAR ADDRESS CIIY 21P PHONE UCENSE� <br />C1R550F WORK <br />� NEW �. �. ADDITION �. . ALTERATION REPAIR � DEMOLITION . WOODSTOVE/FRPL INSERT .] BUILDING RELOCATION <br />TENANT �AIPROVEMENT OR INTERIOP FdEMODEL ONLY CONIACT PERSON AND PHCNE NO <br />� CONTRACT PR CE OF WORK: �C ���� � �i <br />� DESCR�OE WOAK �Np SOUARE FOOTAGEI INVOLVED i <br />Q _ /�%e� t �B!/.�C�' G�Ii�.. <br />LOT <br />vaaecT <br />� 7y�� <br />BLOCN <br />SINK 8 DISP <br />FPONT SETB \CN <br />USEZONE <br />TYPEOFCONS7.PlLOWPBIE <br />51]E Of OLDG <br />OCCUPANGVLOAD <br />RERSON FOR51'RiNNLERS <br />APPIICATION ACC. BV <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION?,ND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />LOW ORAITAGHPOUAGOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />oc NOT. THE GRANTING OF A PERMIT DOES NUT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINCa CONSTRUC.TION OR THE <br />PERFORMANCE OF CONSTRUL'TION. THAT I AM AUTHORIZEO BY THE <br />OWNER OF THIS PROPERTY Td PERFORM iHF WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WIiH THE STATE <br />CONTRACTORS LAW 1827 RCW FND 296.200 WAC. <br />SiGNRTUREOFLONTRnCiORORRUTN031ZE�RGENi ORTE <br />_Ql: ��a r,�a�i+�--- �'% '3 �Q <br />,_ /�.PPIICANT$ CITV BUSMES$ LICENSE NO ANO BUSIN[S$ NAME <br />SUB TOTAL S <br />PERMIT S _ <br />TOTALFEE S <br />REAFSETSAGK I SIpESETBRCN <br />LOTRRER <br />iYPEOfCONSi.FLTURL <br />N0. OF STOPIES <br />FiRE SPpNKlERS REO'0 <br />f -: VES '. � NO <br />PlANSAPPROVEO �Y <br />VACRNT SITE <br />VES NO <br />C4C�PPMCY H] OfbMllM6� <br />GBW1 <br />BRSEMENT <br />. � YES �..� NO <br />HEIGHT IIMITAT10N <br />CITY OF EVEHETT <br />LOCRLSALES <br />TAX CODE IS 3105 <br />UNIT HEATERS—B.TU. M <br />CLOTHES DRYERS <br />VENTILA710N FAN <br />W�TERHEATER <br />METAL FIREPLl�CE 8 <br />HEATPUMP <br />GAS PIPING <br />EXHAUST FAN <br />$ <br />PIRNCHEGKNUMO[ii I F[E I RECEIPiNO. <br />BUiLDIMG � �� <br />PLUMBING <br />MECNANICAL <br />i <br />OTHER <br />STATE BUILDMG SURCHARGE - � 5( <br />STATEENERGVSUHCHARG[ <br />PUOLIC WORNS <br />TOTl1L /II� 1 iC <br />I <br />